[The incidence and causes of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia].

ABSTRACT

Objective: To observe the incidence of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia and to explore the risk factors for its occurrence. Methods: The data of patients suffered from Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia from June 2018 to May 2021 were retrospectively reviewed. The type of procedure, surgeon, age and gender were selected as matching factors, 4 patients without Tapia syndrome were selected as control group for each case. The radiological parameters including mandibular-vertebral distance, thyroid-vertebral distance, thyroid cartilage-vertebral distance, and C2-C7 lordotic Cobb angle were measured on lateral radiographs of the cervical spine. The above parameters were measured on neutral, over-flexion and over-extension radiographs. The difference between the Tapia group and the control group were analyzed. Results: There were 9 patients (0.37%) suffered from Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia in 2 431 patients, and it happened in 0.67 days (0-2 days) after the operation. There were 3 males and 6 females with a mean age of (61±5) years. The clinical manifestations was tongue extension deviation in 8 cases (88.9%), dysarthria in 6 cases (66.7%), dysphagia in 3 cases (33.3%), tongue stiffness in 3 cases (33.3%), hoarseness in voice and pharyngeal discomfort in 1 case (11.1%). All of the symptoms were relieved in all patients at 3 months postoperative follow-up. In neutral position, the mandibular-vertebral distance was (7.19±3.96) mm in the control group and it was (3.98±3.01) mm in Tapia group (P<0.05). From neutral position to hyperflexion position, the distance between mandible and vertebral body was reduced from 3.98 mm to 1.95 mm in the Tapia group and decreased for 51.0%, and it decreased from 7.19 mm for 31.8% to 4.90 mm in the control group. Conclusions: The incidence of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia is low. A smaller mandibular-vertebral distance on pre-operative cervical spine lateral view radiograph maybe a risk factor for Tapia syndrome after posterior cervical surgery under oral tracheal intubation general anesthesia.